Healthcare Provider Details

I. General information

NPI: 1902293814
Provider Name (Legal Business Name): EMILY BURMEISTER MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 HOPE ST
PROVIDENCE RI
02912-9090
US

IV. Provider business mailing address

PO BOX 1933
PROVIDENCE RI
02912-1933
US

V. Phone/Fax

Practice location:
  • Phone: 401-863-3851
  • Fax:
Mailing address:
  • Phone: 401-863-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT00252
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: